Healthcare Provider Details

I. General information

NPI: 1275307811
Provider Name (Legal Business Name): VITAL VEINS LAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 PARK ST STE 200
NAPERVILLE IL
60563-8404
US

IV. Provider business mailing address

1755 PARK ST STE 200
NAPERVILLE IL
60563-8404
US

V. Phone/Fax

Practice location:
  • Phone: 630-339-4244
  • Fax: 630-839-3744
Mailing address:
  • Phone: 630-339-4244
  • Fax: 630-839-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. BRIANA DANTZLER
Title or Position: OWNER
Credential: CPT
Phone: 779-717-3959